scholarly journals Prophylactic premedication can reduce Emergence Agitation after Sevoflurane Anesthesia in Pediatrics: A placebo-controlled prospective trial.

2020 ◽  
Vol 24 (3) ◽  
Author(s):  
Amir Abouzkry ◽  
Sherif Arafa
Keyword(s):  
Prospective Trial ◽  
Pediatric Anesthesia ◽  
Anesthesia Care ◽  
Sevoflurane Anesthesia ◽  
Emergence Agitation ◽  
Web Based ◽  
Risk Of Injury ◽  
Children And Parents ◽  
Increased Risk ◽  
Inhaled Anesthetic

Sevoflurane is an inhaled anesthetic widely used for pediatric anesthesia, but emergence agitation (EA) or emergence delirium (ED) is a common sevoflurane anesthesia recovery-associated problem.1 Emergence agitation is associated with increased risk of injury in children and parents' dissatisfaction with anesthesia care.2 In a web-based survey of pediatric anesthesiologists in Canadian Pediatric Anesthesia Society, 42% felt that EA was a significant problem and 45% of them were giving medication before or during anesthesia to prevent its development.

scholarly journals Comparison of the Effects of 0.03 and 0.05 mg/kg Midazolam with Placebo on Prevention of Emergence Agitation in Children Having Strabismus Surgery

2014 ◽  
Vol 120 (6) ◽  
pp. 1354-1361 ◽  
Author(s):  
Eun Jung Cho ◽  
Seung Zhoo Yoon ◽  
Jang Eun Cho ◽  
Hye Won Lee
Keyword(s):  
Intravenous Administration ◽  
Controlled Trial ◽  
Pediatric Anesthesia ◽  
Strabismus Surgery ◽  
Secondary Outcome ◽  
Sevoflurane Anesthesia ◽  
Emergence Agitation ◽  
Emergence Time ◽  
Double Blind ◽  
To Receive

Abstract Background: Midazolam has been widely studied for preventing emergence agitation. The authors previously reported that in children with sevoflurane anesthesia, intravenous administration of midazolam (0.05 mg/kg) before the end of surgery reduced the incidence of emergence agitation but prolonged the emergence time. This study was designed to test the hypothesis that a lower midazolam dose could suppress emergence agitation with minimal disturbance of the emergence time in children with sevoflurane anesthesia. Methods: In this randomized, double-blind, placebo-controlled trial, 90 children (1 to 13 yr of age) having strabismus surgery were randomized to 1:1:1 to receive 0.03 mg/kg of midazolam, 0.05 mg/kg of midazolam, or saline just before the end of surgery. The primary outcome, the incidence of emergence agitation, was evaluated by using the pediatric anesthesia emergence delirium scale and the four-point agitation scale. The secondary outcome was time to emergence, defined as the time from sevoflurane discontinuation to the time to extubation. Results: The incidence of emergence agitation was lower in patients given 0.03 mg/kg of midazolam (5 of 30, 16.7%) and patients given 0.05 mg/kg of midazolam (5 of 30, 16.7%) compared with that in patients given saline (13/of 30, 43.3%; P = 0.036 each). The emergence time was longer in patients given 0.05 mg/kg of midazolam (17.1 ± 3.4 min, mean ± SD) compared with that in patients given 0.03 mg/kg of midazolam (14.1 ± 3.6 min; P = 0.0009) or saline (12.8 ± 4.1 min; P = 0.0003). Conclusion: Intravenous administration of 0.03 mg/kg of midazolam just before the end of surgery reduces emergence agitation without delaying the emergence time in children having strabismus surgery with sevoflurane anesthesia. (Anesthesiology 2014; 120:1354-61)

Emergence Agitation

2013 ◽  
Author(s):  
Charles B Eastwood ◽  
Paul J Samuels
Keyword(s):  
Patient Safety ◽  
Pediatric Anesthesia ◽  
Medication Administration ◽  
Parental Satisfaction ◽  
Anesthesia Care ◽  
Post Anesthesia Care Unit ◽  
Emergence Agitation ◽  
Urinary Catheters ◽  
Emergence Delirium ◽  
Present Understanding

Emergence delirium is a common and challenging post-anesthetic complication in children characterized by a brief period of inconsolability, disorientation, and combativeness. Emergence delirium threatens patient safety due to potential self-injurious behavior or by untimely removal of intravenous lines, urinary catheters, and surgical drains. The economic impact of emergence delirium is a consequence of delayed post-anesthesia care unit (PACU) discharge and the need for additional medication administration and increased PACU staffing. In addition, despite the short duration of emergence delirium, its dramatic and frightening presentation can diminish parental satisfaction. Although no consistently effective treatment for emergence delirium has been described, familiarity with this clinical entity and approaches to its management and prevention are important to those who provide pediatric anesthesia care. This chapter will focus on our present understanding of emergence delirium in children.

scholarly journals Effects of ketamine and ketamine with midazolam on emergence agitation in children following sevoflurane anesthesia

2018 ◽  
Vol 4 (2) ◽  
pp. 57-65
Author(s):  
Achyut Sharma ◽  
Resham Bahadur Rana
Keyword(s):  
Controlled Trial ◽  
Pediatric Anesthesia ◽  
Sevoflurane Anesthesia ◽  
Emergence Agitation ◽  
Ophthalmic Surgery ◽  
Prospective Randomized Controlled Trial ◽  
Recovery Times ◽  
The Mean ◽  
The Cost ◽  
Mean Time

Background : Emergence agitation is a distressful phenomenon associated with inhalational agents such as Sevoflurane in short surgical procedures. Various drugs have been used in the past but some come at the cost of increased complications. We aim to study the effects of ketamine alone and ketamine with midazolam on emergence agitation and their effects on recovery and discharge times.Methods: We conducted a prospective randomized controlled trial among 94 patients aged two to ten years presenting for ophthalmic surgeries in which 45 patients were allocated to each group: group K (Ketamine) and group KM (Ketamine with Midazolam). Group K received Ketamine 0.3 mg/kg IV and Group KM received Ketamine 0.3 mg/kg IV and Midazolam 0.03 mg/kg IV. Intraoperatively heart rate and post-operatively emergence agitation, recovery times, discharge times were studied.Results: Demographic variables were comparable between the two groups. Median Pediatric Anesthesia Emergence Delirium (PAED) score of 6 with IQR (4-6) in group K was comparable to the median score of 5 with IQR (4-6) in group KM. The mean recovery time of 22}4.82 min in group K was significantly lower compared to the mean time of 25.75}3.32 min in group KM. Mean time to discharge of 67}11 min from the hospital in group K was significantly shorter compared to that in group KM (108}18 mins).Conclusion: We concluded from our study that ketamine alone is as effective as ketamine with midazolam in reducing the emergence agitation following Sevoflurane anesthesia for ophthalmic surgery. Journal of Society of Anesthesiologists of NepalVol. 4, No. 2, 2017, page: 57-65

scholarly journals RETRACTED ARTICLE: Desflurane anesthesia worsens emergence agitation in adult patients undergoing thyroid surgery compared to sevoflurane anesthesia

2017 ◽  
Vol 3 (1) ◽  
Author(s):  
Takeshi Suzuki ◽  
Takuya Kurazumi ◽  
Tomomi Ueda ◽  
Hiromasa Nagata ◽  
Takashige Yamada ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Thyroid Surgery ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Pediatric Anesthesia ◽  
Adult Patients ◽  
Sevoflurane Anesthesia ◽  
Emergence Agitation ◽  
Extubation Time ◽  
Group D

Abstract Background The effect of volatile anesthetics on emergence agitation in adults remains unclear. We compared the degree of emergence agitation between desflurane and sevoflurane anesthesia in adults undergoing thyroid surgery. Findings One hundred and sixteen patients with American Society of Anesthesiologists status 1 or 2 were randomized into two groups: the desflurane group (group D) and the sevoflurane group (group S). After induction of anesthesia with fentanyl (1–2 μg/kg) and propofol (1.5–2.5 mg/kg), tracheal intubation was facilitated with suxamethonium (0.5–1.0 mg/kg). In group D, anesthesia was maintained with desflurane in 66% nitrous oxide and 33% oxygen supplemented with fentanyl when necessary; in group S, sevoflurane was used instead of desflurane. After the end of the surgery, emergence agitation was evaluated with a modified pediatric anesthesia emergence delirium scale (ranging from 0 to 16, with higher scores indicating more severe emergence agitation) before extubation. Time to extubation from the end of the surgery, postoperative pain (evaluated by a numerical rating scale [NRS]), and postoperative nausea and vomiting (PONV) after surgery were examined. The degree of emergence agitation was more severe in group D than in group S (median [interquartile range]: 5 [4–7] vs 4 [2–6], p = 0.008). Time to extubation, NRS scores, and PONV rates were similar between the two groups. Conclusions Desflurane anesthesia worsened emergence agitation as compared with sevoflurane in adult patients undergoing thyroid surgery, but did not affect time to extubation, postoperative pain, or PONV. Trial registration UMIN000014215

Effectiveness of a web-based medication adherence tool with patient centered communication: Results of a clustered randomized controlled trial (Preprint)

2019 ◽  
Author(s):  
Jan van Lieshout ◽  
Joyca Lacroix ◽  
Aart van Halteren ◽  
Martina Teichert
Keyword(s):  
Randomized Controlled Trial ◽  
Medication Adherence ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Community Pharmacies ◽  
Web Based ◽  
Randomized Controlled ◽  
Tailored Interventions ◽  
Increased Risk

BACKGROUND Growing numbers of people use medication for chronic conditions; non-adherence is common, leading to poor disease control. A newly developed web-based tool to identify an increased risk for non-adherence with related potential individual barriers might facilitate tailored interventions and improve adherence. OBJECTIVE To assess the effectiveness of the newly developed tool to improve medication adherence. METHODS A cluster randomized controlled trial assessed the effectiveness of this adherence tool in patients initiating cardiovascular or oral blood glucose lowering medication. Participants were included in community pharmacies. They completed an online questionnaire comprising an assessments of their risk for medication non-adherence and subsequently of barriers to adherence. In pharmacies belonging to the intervention group, individual barriers displayed in a graphical profile on a tablet were discussed by pharmacists and patients at high non-adherence risk in face to face meetings and shared with their general practitioners and practice nurses. Tailored interventions were initiated by the healthcare providers. Barriers of control patients were not presented or discussed and these patients received usual care. The primary outcome was the difference in medication adherence at 8 months follow-up between patients with an increased non-adherence risk from intervention and control group, calculated from dispensing data. RESULTS Data from 492 participants in 15 community pharmacies were available for analyses (intervention 253, 7 pharmacies; control 239, 8 pharmacies). The intervention had no effect on medication adherence (-0.01; 95%CI -0.59 – 0.57; P= .96), neither in the post hoc per protocol analysis (0.19; 95%CI -0.50 – 0.89; P=.58). CONCLUSIONS This study showed no effectiveness of a risk stratification and tailored intervention addressing personal barriers for medication adherence. Various potential explanations for lack of effect were identified. These explanations relate for instance to high medication adherence in the control group, study power and fidelity. Process evaluation should elicit possible improvements and inform the redesign of intervention and implementation. CLINICALTRIAL The Netherlands National Trial Register: NTR5186. Date: May 18, 2015 (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5186)

scholarly journals The Relationship between Dynamic Balance and Jumping Tests among Adolescent Amateur Rugby Players. A Preliminary Study

2021 ◽  
Vol 18 (1) ◽  
pp. 312
Author(s):  
Bartosz Wilczyński ◽  
Jakub Hinca ◽  
Daniel Ślęzak ◽  
Katarzyna Zorena
Keyword(s):  
Injury Risk ◽  
Dynamic Balance ◽  
Study Data ◽  
Balance Test ◽  
Risk Of Injury ◽  
Counter Movement Jump ◽  
Increased Risk ◽  
Positive Correlations ◽  
The Relationship ◽  
Rugby Players

Rugby is a demanding contact sport. In light of research, poor balance, reduced jumping ability, muscle strength, and incorrect landing patterns might contribute to the increased risk of injury in athletes. Investigating the relationship between tests assessing these abilities might not only allow for the skillful programming of preventive training but also helps in assessing the risk of injury to athletes. Thus, the main purpose of this study was to investigate the relationship between dynamic balance, vertical and horizontal jumps, and jump-landings movement patterns. Thirty-one healthy amateur adolescent rugby players (age: 14.3 ± 1.6 years, height 171.4 ± 9.7 cm, body mass 80 ± 26 kg) participated in the study. Data were collected by the Y-balance Test (YBT), Counter Movement Jump (CMJ), Single Leg Hop for Distance (SLHD), and Landing Error Score System (LESS). Significant positive correlations were found between SLHD both legs (SLHDb) and YBT Composite both legs (COMb) (r = 0.51, p = 0.0037) and between SLHDb and CMJ (r = 0.72, p < 0.0001). A relationship was also observed between the CMJ and YBT COMb test (r = 0.51, p = 0.006). Moderate positive correlations were found between the dominant legs in SLHD and the posterolateral (r = 0.40, p = 0.027), posteromedial (r = 0.43, p = 0.014), and composite (r = 0.48, p = 0.006) directions of the YBT. These results indicate that variables that are dependent on each other can support in the assessment of injury-risk and in enhancing sports performance of young athletes.

Increased Risk of Injury Following a Diagnosis of Vertigo: A Population‐based Study

2021 ◽  
Author(s):  
Tzong‐Hann Yang ◽  
Sudha Xirasagar ◽  
Yen‐Fu Cheng ◽  
Chia‐Hui Wang ◽  
Herng‐Ching Lin
Keyword(s):  
Population Based ◽  
Population Based Study ◽  
Risk Of Injury ◽  
Increased Risk

scholarly journals Protection Against Spikes in Workload With Aerobic Fitness and Playing Experience: The Role of the Acute:Chronic Workload Ratio on Injury Risk in Elite Gaelic Football

2017 ◽  
Vol 12 (3) ◽  
pp. 393-401 ◽  
Author(s):  
Shane Malone ◽  
Mark Roe ◽  
Dominic A. Doran ◽  
Tim J. Gabbett ◽  
Kieran D. Collins
Keyword(s):  
Aerobic Fitness ◽  
Injury Risk ◽  
Perceived Exertion ◽  
Reference Group ◽  
Time Trial ◽  
Rating Of Perceived Exertion ◽  
Football Players ◽  
Risk Of Injury ◽  
Increased Risk ◽  
Injury Protection

Purpose:To examine the association between combined session rating of perceived exertion (RPE) workload measures and injury risk in elite Gaelic footballers.Methods:Thirty-seven elite Gaelic footballers (mean ± SD age 24.2 ± 2.9 y) from 1 elite squad were involved in a single-season study. Weekly workload (session RPE multiplied by duration) and all time-loss injuries (including subsequent-wk injuries) were recorded during the period. Rolling weekly sums and wk-to-wk changes in workload were measured, enabling the calculation of the acute:chronic workload ratio by dividing acute workload (ie, 1-weekly workload) by chronic workload (ie, rolling-average 4-weekly workload). Workload measures were then modeled against data for all injuries sustained using a logistic-regression model. Odds ratios (ORs) were reported against a reference group.Results:High 1-weekly workloads (≥2770 arbitrary units [AU], OR = 1.63–6.75) were associated with significantly higher risk of injury than in a low-training-load reference group (<1250 AU). When exposed to spikes in workload (acute:chronic workload ratio >1.5), players with 1 y experience had a higher risk of injury (OR = 2.22) and players with 2–3 (OR = 0.20) and 4–6 y (OR = 0.24) of experience had a lower risk of injury. Players with poorer aerobic fitness (estimated from a 1-km time trial) had a higher injury risk than those with higher aerobic fitness (OR = 1.50–2.50). An acute:chronic workload ratio of (≥2.0) demonstrated the greatest risk of injury.Conclusions:These findings highlight an increased risk of injury for elite Gaelic football players with high (>2.0) acute:chronic workload ratios and high weekly workloads. A high aerobic capacity and playing experience appears to offer injury protection against rapid changes in workload and high acute:chronic workload ratios. Moderate workloads, coupled with moderate to high changes in the acute:chronic workload ratio, appear to be protective for Gaelic football players.

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